Case

Case Studies
A.H. Rebar1, P.S. MacWilliams2, B.F. Feldman3, F.L. Metzger4, R.V.H. Pollock5 and J. Roche6
1
Dept of Veterinary Pathobiology, School of Veterinary Medicine, Purdue University,

IN,USA. 2Dept of Pathobiological Sciences, School of Veterinary Medicine, University of
Wisconsin, WI, USA. 3Dept of Biomedical Sciences & Pathobiology, VA-MD - Regional
College of Veterinary Medicine, Virginia Tech, VA, USA. 4Metzger Animal Hospital, State
College, PA, USA. 5Fort Hill Company, Montchanin, DE, USA. 6Hematology Systems,
IDEXX Laboratories, Westbrook, ME, USA.
Case 1: Feline 8 Month Old Intact Male DSH

Case 2: Canine 6 Year Old Castrated Male Dachshund
Case 3: Canine 15 Year Old Castrated Male Cocker Spaniel
Case 4: Canine 5 Year Old Spayed Female Sheepdog
Case 5: Feline 4 Year Old Castrated Male Domestic Longhair
Case 6: Canine 11 Year Old Female Husky
Case 7: Canine 4 Week Old Male Greyhound
Case 8: Canine 5 Year Old Female Cocker Spaniel
Case 9: Canine 2 Year Old Intact Female Labrador
Case 10: 9 Year Old Neutered Male Gordon Setter
Case 11: Feline 10 Month Old Female Siamese
Case 12: Canine 1 Year Old Intact Male Collie
Case 13: Canine 1 Year Old Intact Female Boxer
Case 14: Feline 10 Year Old Castrated Male Tabby DSH
Case 15: Canine 14 Year Old Intact Female Cocker Spaniel
Case 16: Feline 9 Year Old Spayed Female Persian
Case 17: Feline 4 Year Old Intact Female DSH
Case 18: Canine 10 Year Old Female Sheltie
Case 19: Feline 4 Year Old Male DSH
Case 20: Canine 9 Year Old Female Golden Retriever
Case 21: Canine 2 Year Old Standard Poodle
Case 22: Canine 6 Year Old Male English Bull Dog
Case 23: Canine 9 Year Old Castrated Male Mixed Breed
Case 24: Canine 9 Year Old Spayed Female Corgi
Case 25: Canine 11 Year Old Spayed Female Basset Hound
Case 26: Feline 7 Year Old Male Domestic Shorthair
Case 27: Canine 12 Year Old Mixed Breed Male
Case 28: Canine 7 Year Old Mixed Breed Spayed Female
Case 29: Canine 5 Year Old Mixed Breed Intact Male
Case 1
Feline 8 Month Old Intact Male DSH
History
Cat presented for castration and declaw surgery.

Physical Examination
Normal temperature, pulse, and respiration (TPR). Cat is extremely fractious (nangis) and is
salivating profusely.
PCV %
Hgb g/dl
RBC x106/ul
MCV fl
MCH pg
MCHC g/dl
TPP g/dl
Platelets
Laboratory Data
Patient
Reference Range
35
(30 - 40)
WBC/ul
11.6
(8.5 - 15)
Neutrophils
7.6
(5.2 - 10)
Band cells
46
(39 - 55)
Lymphocytes
15
(13 - 17)
Monocytes
33
(30 - 36)
Eosinophils
7.1
(6.0 - 7.5)
ADQ
Patient
26,500
13,250
12,455
795
-
Reference Range
(5,500 - 19,500)
(2,500 - 12,500)
(0 - 300)
(1,500 - 7,000)
(0 - 850)
(0 - 750)
Discussion/Interpretation
CBC reveals a marked lymphocytosis with a slight mature neutrophilia. Causes of

lymphocytosis include chronic infection or inflammation, lymphocytic leukemia, and
physiologic lymphocytosis. Examination of the blood film reveals numerous small
lymphocytes. Lymphoblasts or atypical lymphocytes were not observed. Tests for FeLV and
FIV were negative.
This is an example of a physiologic lymphocytosis and neutrophilia in a young, healthy,

scared cat. Epinephrine release causes demargination of neutrophils and lymphocytosis. Both
changes are transient and values return to normal within 1 - 2 hours.
Case 2
Canine 6 Year Old Castrated Male Dachshund
History
Back pain with posterior paresis for 2 days.

Intervertebral disc protrusion at T13 - L1.
PCV %
Hgb g/dl
RBC x106/ul
MCV fl
MCH pg
MCHC g/dl
TPP g/dl
Platelets
Laboratory Data
Patient
Reference Range
40
(37 - 55)
WBC/ul
13.3
(12 - 18)
Neutrophils
6.0
(5.5 - 8.5)
Band cells
66
(60 - 77)
Lymphocytes
22
(19 - 24)
Monocytes
33
(32 - 36)
Eosinophils
7.5
(6.0 - 7.5)
ADQ
Patient
28,000
25,200
840
1,960
-
Reference Range
(6,000 - 17,000)
(3,000 - 11,400)
(0 - 300)
(1,000 - 4,800)
(150 - 1,350)
(100 - 750)
The leukogram reveals a lymphopenia, eosinopenia, and a leukocytosis due to a neutrophilia

without a left shift and a monocytosis. These changes represent the effects of glucocorticoid
therapy. The dog had been given 3 mg/kg dexamethasone 2 days prior to the CBC.
Glucocorticoids cause a mature neutrophilia by increasing release of mature neutrophils from
the marrow storage pool, demarginating neutrophils from the marginal neutrophil pool
(MNP) into the circulating neutrophil pool (CNP), and decreasing neutrophil migration into
tissues. The leukocyte changes will revert to normal within a few days after cessation of
glucocorticoid therapy. It is important that this leukocyte pattern not be confused with the
response seen with inflammation.
This leukocyte pattern also can be typical of hyperadrenocorticism.
Case 3
Canine 15 Year Old Castrated Male Cocker Spaniel
History
Vomiting (muntah) for 5 days.

Dog is obese, depressed, and severely dehydrated.
PCV %
Hgb g/dl
RBC x106/ul
MCV fl
MCH pg
MCHC g/dl
TPP g/dl
Platelets
Toxic neutrophils 3+
Laboratory Data
Patient Reference Range
42
(37 - 55)
WBC/ul
14.0
(12 - 18)
Neutrophils
6.2
(5.5 - 8.5)
Band cells
67
(60 - 77)
Lymphocytes
22
(19 - 24)
Monocytes
34
(32 - 36)
Eosinophils
9.0
(6.0 - 7.5)
ADQ
Patient
22,400
13,884
2,240
1,568
4,256
224
Reference Range
(6,000 - 17,000)
(3,000 - 11,400)
(0 - 300)
(1,000 - 4,800)
(150 - 1,350)
(100 - 750)
History of vomiting suggests that hyperproteinemia is due to dehydration. A leukocytosis is

present due to a neutrophilia with a left shift (Shift to the left menunjukan jumlah sel
neutrofil muda meningkat di darah. Hal ini bisa terjadi karena infeksi akut, proses
inflamasi akut, atau proses nekrosis jaringan yang akut.) (Fig. c3-1) and
monocytosis. Toxic change is evident in circulating neutrophils. The leukocyte pattern
indicates acute inflammation with tissue necrosis. An abdominocentesis revealed a septic

neutrophilic exudate (Fig. c3-2). Serum amylase and lipase activities were both increased.
The clinical diagnosis was necrotizing pancreatitis with septic peritonitis.
Figure c3-1.Canine toxic band neutrophil. Inflammation or toxemia causes morphologic

changes in neutrophils. In this band neutrophil, cytoplasmic basophilia, vacuolation, and a
Dohle body are evident (100x). To view click on figure
Figure c3-2.Abdominal fluid. Swollen degenerate neutrophils with phagocytosed bacteria

indicate septic peritonitis which has caused a left shift with toxic neutrophils in the CBC
(100x). To view click on figure
Case 4
Canine 5 Year Old Spayed Female Sheepdog
History
Partial anorexia and intermittent vomiting. Owner reports that dog is "not her usual self"
during the last 2 weeks.
No abnormalities detected.
Patient
PCV %
Hgb g/dl
RBC x106/ul
MCV fl
35
11.9
5.6
66
Laboratory Data
Reference Range
(37 - 55)
WBC/ul
(12 - 18)
Neutrophils
(5.5 - 8.5)
Band cells
(60 - 77)
Lymphocytes
Patient
23,400
20,124
234
1,404
Reference Range
(6,000 - 17,000)
(3,000 - 11,400)
(0 - 300)
(1,000 - 4,800)
Patient
MCH pg
MCHC g/dl
TPP g/dl
Plasma color
Reticulocytes %
Absolute Retic/ul
Platelets/uL
NRBC
Laboratory Data
Reference Range
(19 - 24)
Monocytes
(32 - 36)
Eosinophils
(6.0 - 7.5)
22
33
7.3
Normal
0.4
(<1.0)
22,400
(<80,000)
231,000
(>200,000)
69/100 WBC
RBC morphology:

1,638 (150 - 1,350)
(100 - 750)
Anisocytosis 1+
Target cells 2+
Basophilic stippling 1+
The CBC is unusual in that there is mild anemia with numerous NRBCs (metarubricytes).
However, the metarubricytosis is not accompanied by significant anisocytosis, macrocytosis,
polychromasia, or an increase in reticulocytes (Fig. c4-1). In addition, the anemia is mild and
the number of NRBCs is out of proportion to the severity of anemia. This is a
nonregenerative anemia because the response is disordered and causes of inappropriate
metarubricytosis should be pursued. These include marrow neoplasia, myelofibrosis, lead
poisoning, myelophthisis, extramedullary hematopoiesis, or severe anoxia. Basophilic
stippling can be associated with lead poisoning but is not a consistent feature (Fig. c4-2).
Basophilic stippling can also be seen in blood films of dogs and cats with intense
erythrogenic responses to severe anemia. In this dog, the inappropriate release of
metarubricytes and the stippling are reasons to submit blood for lead analysis. The blood lead
level was 1.6 ppm (normal Pb <0.35 ppm). A neutrophilic leukocytosis and monocytosis are
present suggesting an inflammatory response with tissue necrosis.
Diagnosis
Inappropriate metarubricytosis due to lead poisoning.
Figure c4-1.Canine blood. Several NRBCs are noted in the field that are not accompanied by
polychromasia or anisocytosis. In a dog that has a very mild anemia, the NRBCs represent an
inappropriate response. Causes of inappropriate metarubricytosis include acute anoxia,
marrow neoplasia, myelofibrosis, extramedullary hematopoiesis, myelophthisis and lead
poisoning (40x). To view click on figure
Figure c4-2. Canine blood. RBCs are crenated and several target cells are noted. Basophilic
stippling is evident in the large RBC in center of the field as blue-black granules in the
periphery of the cytoplasm. Basophilic stippling is an inconsistent finding in lead poisoning
Case 5
Feline 4 Year Old Castrated Male Domestic Longhair
History
Weight loss, anorexia, and listless (lesu ) for 3 weeks. Owner reports that cat never goes
outside.
Mucous membranes are white, rapid pulse, moderate weight loss, enlarged spleen and liver.
PCV %
Hgb g/dl
RBC x106/ul
MCV fl
MCH pg
MCHC g/dl
TPP g/dl
Patient
12
4.2
2.05
58
19
35
7.7
Laboratory Data
Reference Range
(30 - 40)
WBC/ul
(8.5 - 15)
Neutrophils
(5.2 - 10)
Band cells
(39 - 55)
Lymphocytes
(13 - 17)
Monocytes
(30 - 36)
Eosinophils
(6.0 - 7.5)
Patient
13,000
3,510
5,460
910
130
Reference Range
(5,500 - 19,500)
(2,500 - 12,500)
(0 - 300)
(1,500 - 7,000)
(0 - 850)
(0 - 750)
Laboratory Data
Patient
Reference Range
Platelets/ul
170,000
(>300,000)
Reticulocytes % 1.0
(<0.6%)
Absolute Retic/ul 20,500
(<80,000)
Plasma color
normal
Blasts
2,990
NRBC
425/100 WBC
RBC Morphology:
Normal
The uncorrected WBC count was 77,200/ul. The difference between this value and the
reported WBC count is due to the correction for NRBCs. Severe anemia is present with an
increase in MCV and numerous NRBCs. However, the increased MCV and metarubricytosis
are not accompanied by anisocytosis, polychromasia, or reticulocytosis (Fig. c5-1). The
anemia in this cat is nonregenerative because the morphologic response was not orderly or
proportional to the severity of anemia. Blast cells were quite large and had dark blue
cytoplasm, focal perinuclear clear zone, round eccentric nucleus, and a single large nucleolus
(Fig. c5-2a, Fig. c5-2b and Fig. c5-3). Mitotic figures were noted occasionally. The presence
of blast cells, nonregenerative anemia, and thrombocytopenia are indications for bone
marrow examination. The increase in MCV is probably due to macrocytosis and the fact that
the electronic counter is including large leukocytes and blast cells in the RBC volume
analysis. FeLV antigen test was positive. A bone marrow aspirate revealed diffuse infiltration
with blast cells identical to those seen in blood (Fig. c5-4). Developing granulocytes and
megakaryocytes were infrequent.
Diagnosis
Myeloproliferative neoplasm (Erythroleukemia).
Figure c5-1. Feline blood. Numerous NRBCs are present without any evidence of
polychromasia, macrocytosis, or anisocytosis. These findings indicate that the anemia is
nonregenerative. Platelets are not observed in the field (100x). To view click on figure
Figure c5-2a. Blast cells (arrow) are noted that are larger than a neutrophil and have an
eccentric nucleus, irregular chromatin, prominent nucleoli, and focal clear zone in a dark
basophilic cytoplasm. To view click on figure
Figure c5-2b. Large amorphous pink staining aggregates (arrows) are disintegrated nuclei
Figure c5-3. Peripheral edge of smear. Numerous disintegrated nuclei of blast cells are
concentrated on the feather edge of the smear. Blast cells are fragile and tend to fragment
during the preparation of smears (100x). To view click on figure
Figure c5-4. Bone marrow. Nonregenerative anemia, NRBCs without polychromasia, and
blast cells are clear indications for bone marrow examination. Normal granulocytic and
erythroid cells have been replaced by a homogenous population of blast cells identical to
those seen in blood. Because of this neoplastic proliferation, the cat is severely anemic,
thrombocytopenic, and leukopenic (100x). To view click on figure
Case 6
Canine 11 Year Old Female Husky
History
Weight loss, diminished appetite, decreased exercise tolerance, loose stools (mencret) for
several weeks.
Pale mucous membranes, dark tarry stools. Dog is fractious and difficult to examine.
PCV %
Hgb g/dl
RBC x106/ul
MCV fl
MCH pg
Patient
11
2.9
2.66
42
10
Laboratory Data
Reference Range
(37 - 55)
WBC/ul
(12 - 15)
Neutrophils
(5.5 - 8.5)
Band cells
(60 - 77)
Lymphocytes
(19 - 24)
Monocytes
Patient
27,400
19,454
6,302
1,370
Reference Range
(6,000 - 17,000)
(3,000 - 11,400)
(0 - 300)
(1,000 - 4,800)
(150 - 1,350)
Patient
MCHC g/dl
TPP g/dl
Plasma color
Reticulocytes %
Absolute Retic/ul
Platelets/uL
NRBC
Laboratory Data
Reference Range
(32 - 36)
Eosinophils
(6.0 - 7.5)
23
6.0
Normal
3.3
(<1.0)
87,780
(<80,000)
780,000
(>200,000)
7/100 WBC
RBC Morphology:

274
(100 - 750)
Anisocytosis 2+
Microcytosis 2+
Polychromasia 1+
Hypochromia 3+
Poikilocytosis 3+
Severe anemia and hypoproteinemia are evident. On initial inspection, it appears there is a
regenerative response because of the anisocytosis, polychromasia, NRBCs, and reticulocyte
increase. Several findings indicate that the regenerative response is abnormal. The RBC
indices and morphology reveal a microcytic and hypochromic anemia (Fig. c6-1a and Fig.
c6-1b) instead of the normal regenerative response to blood loss, which is macrocytic and
hypochromic. Although the reticulocyte percentage is increased slightly, the absolute
reticulocyte count does not indicate a significant reticulocyte response. Serum iron and serum
iron binding capacity were measured and confirmed iron deficiency (Iron = 38 ug/dl,
Reference Range 89 - 138; IBC = 360 ug/dl, Reference Range 177 - 400). Although the
change can be subtle, RBCs in iron deficient animals are smaller and have a much larger area
of central pallor due to insufficient hemoglobin content (Fig. c6-2).
Polychromatophilic RBCs and NRBCs are poorly hemoglobinated and have a vacuolated or
moth-eaten cytoplasms. Marked poikilocytosis and thrombocytosis are also features of iron
deficiency. A mature neutrophilia, monocytosis, and lymphocytosis are evident in the
leukogram and are consistent with chronic inflammation. A new steady state in neutrophil
kinetics has evolved characterized by increased neutrophil production in marrow that is equal
to tissue demand. Atypical lymphocytes or lymphoblasts were not observed on the blood
film. The dog was sedated for a more thorough examination which revealed a firm midabdominal mass. Ultrasound examination confirmed an intestinal mass with mixed
echogenicity. Fine needle aspiration of the abdominal mass revealed a pleomorphic
population of epithelial cells (Fig. c6-3).
Diagnosis
Intestinal carcinoma (Fig. c6-4) with chronic GI hemorrhage that caused a secondary iron
deficiency anemia.
Figure c6-1a. Canine blood. Blood from the dog in Case 6 is compared with normal canine
RBCs. A. Microcytosis and hypochromia is pronounced when compared with the normal
RBCs in B (40x). To view click on figure
Figure c6-1b. Canine blood. Blood from the dog in Case 6 is compared with normal canine
RBCs. A. Microcytosis and hypochromia is pronounced when compared with the normal
RBCs in B (40x). To view click on figure
Figure c6-2. Canine blood. Microcytes, poikilocytes, and hypochromic RBCs are evident.
Hypochromic RBCs have a larger area of central pallor with a thin and reduced rim of
hemoglobin staining. Iron deficiency anemia is the most frequent cause of these changes in
dogs and cats (100x). To view click on figure
Figure c6-3. Aspirate of abdominal mass. A sheet of pleomorphic epithelial cells with marked
anisocytosis, anisokaryosis, variable N:C ratios, and irregular chromatin confirms the
presence of carcinoma (100x). To view click on figure
Figure c6-4. Loop of bowel with large carcinoma. Note the ulcerated luminal surface which
caused chronic hemorrhage and secondary iron deficiency anemia. To view click on figure
Case 7
Canine 4 Week Old Male Greyhound
History
Puppy was healthy at birth and during the first week of life. At 2 - 3 weeks of age, puppy
became acutely depressed, stopped eating, and seemed pale. In spite of supportive care, about
50 - 60% of puppies in previous litters died within a few days of showing clinical signs.
Moderate depression, weakness, lack of appetite, fever (T= 103.8F) and mucous membranes
are pale and icteric. Feces are formed and bright orange in color. The spleen is enlarged. The
puppy is heavily infested with ticks.
PCV %
Hgb g/dl
RBC x106/ul
MCV fl
MCH pg
MCHC g/dl
TPP g/dl
Reticulocytes %
Absolute Retic/ul
Plasma color
Platelets/ul
Laboratory Data
10%
(37 - 55)
WBC/ul
2.9
(12 - 18)
Neutrophils
1.43
(4.95 - 7.87)
Band cells
70
(60 - 77)
Lymphocytes
20
(19 - 24)
Monocytes
29
(32 - 36)
Eosinophils
4.5
(6.0 - 7.5)
10.2
(<1.0)
145,800 (<80,000)
4+icterus
35,000
(>200,000)
RBC Morphology:
Anisocytosis 3+
Polychromasia 3+
Macrocytosis 3+
Selected Chemistries
Alanine
Aminotransferase (ALT) IU/L
Total Bilirubin mg/dl
Urine
Color
Amber
SG
1.035
pH
6
Bilirubin
4+
Blood
1+
Protein
1+
Sediment
Bile crystals
Fecal flotation
Few hookworm ova
Patient
156
12.4
Patient
33,000
27,000
3,500
800
1,700
-
Reference Range
(6,000 - 17,000)
(3,000 - 11,400)
(0 - 300)
(1,000 - 4,800)
(150 - 1,350)
(100 - 750)
Reference Range
(4 - 66)
(0.1 - 0.6)
The RBC morphology and reticulocytosis indicate regenerative anemia. Icterus, bilirubinuria,
splenomegaly, and orange colored feces and the absence of hemorrhage indicate hemolytic
disease. Causes of hemolysis include infectious agents, toxins, immune-mediated destruction,
fragmentation, osmotic lysis, and congenital hemolytic disease. The blood films were
reexamined for the presence of RBC parasites, Heinz bodies, spherocytes, schistocytes, and
ghosts. Serologic tests for Leptospira were negative. A direct Coombs test was positive. A
few Babesia canis organisms were identified in RBCs on the initial blood film (Fig. c7-1).
Impression smear of spleen from a dead puppy revealed numerous Babesia organisms within
RBCs (Fig. c7-2). Puppies were treated with diminazene aceturate. Aggressive tick control
was initiated to control the transmission via ticks.
Figure c7-1. Babesia canis. Pairs of basophilic, pyriform, protozoal organisms are noted in
the RBCs. Stain precipitate is also present as basophilic granules covering some RBCs
Figure c7-2. Splenic impression smear, Babesia canis. Round to oval parasites are noted
within several RBCs. Round basophilic nuclear structure is noted within each protozoal
organism. Disintegrated nuclei of lymphocytes are noted as round pink amorphous aggregates
The absence of an increase in MCV and the hypoproteinemia are likely due to blood loss and
iron depletion secondary to hookworm disease. Hemolytic anemia and thrombocytopenia in
Babesiosis are caused by immune-mediated destruction that targets RBCs and platelets. Thus,
it is not unusual for the Coombs' test to be positive.
White cell data indicate an inflammatory leukogram with superimposed stress and tissue
necrosis. Such a pattern is common in hemolytic conditions. The cause of the inflammatory
response is the destruction of circulating red cells.
Diagnosis
Hemolytic anemia due to Babesia canis complicated by hookworm disease.
Case 8
Canine 5 Year Old Female Cocker Spaniel
History
Owner states that dog is not well and that urine appears very dark. Treated with antibiotics for
a bladder infection by the previous veterinarian.
T=104F, mucous membranes are pale and icteric, large firm mass in mid-abdomen. Mild
dehydration is present.
Patient
PCV %
Hgb g/dl
RBC x106/ul
MCV fl
MCH pg
MCHC g/dl
TPP g/dl
11.5
3.4
1.3
88
26
29
8.3
Icteric, slight
Plasma color
hemolysis
Reticulocytes % 23
Platelets/ul
240,000
NRBC
1,840/100WBC
Laboratory Data
Reference
Range
(37 - 55)
(12 - 18)
(4.95 - 7.87)
(60-77)
(19 - 24)
(32 - 36)
(6.0 - 7.5)

WBC/ul
Neutrophils
Band cells
Lymphocytes
Monocytes
Eosinophils
46,000
34,120
3,600
2,300
3,680
460
(6,000 - 17,000)
(3,000 - 11,400)
(0 - 300)
(1,000 - 4,800)
(150 - 1,350)
(100 - 750)
(<1.0)
(<80,000)
(>200,000)
RBC Morphology:
Anisocytosis, macrocytosis, polychromasia 3+
Spherocytes 3+
Ghosts 1+
Agglutination 1+
Selected
Reference
Patient
Chemistries
Range
7.9
Total Bilirubin
(0.1 - 0.6)
mg/dl
ALT
693 IU/L (4 - 66)
The clinical presentation and laboratory data could lead in several different directions.
Icterus, increased total bilirubin and increased ALT activity could indicate liver disease.
Abdominal mass, fever, neutrophilic leukocytosis, left shift and monocytosis are compatible
with inflammatory disease such as pyometra in an intact female.
Icterus can be caused by hemolytic disease, hepatic disease, or bile duct obstruction. In an
icteric animal, always check first for evidence of hemolytic anemia. The CBC results indicate
a marked regenerative response (increased reticulocytes and MCV) and the slide examination
reveals anisocytosis, polychromasia, macrocytosis, NRBCs, and numerous spherocytes and
ghosts (Fig. c8-1, Fig. c8-2, Fig. c8-3, and Fig. c8-4). These findings are consistent with
hemolytic anemia due to immune-mediated RBC destruction. No RBC parasites were
observed. The increased total protein is likely due to dehydration.
The leukocytosis with left shift is very pronounced but can be a feature of immune-mediated
hemolytic anemia. The increases in ALT and total bilirubin represent the combined effects of
acute RBC destruction with excess bilirubin production and secondary liver damage due to
hypoxic injury as a result of severe acute anemia.
Figure c8-1. RBCs from dog with immune-mediated hemolytic anemia. Anisocytosis is
marked due to the presence of macrocytic polychromatophilic erythrocytes and spherocytes
(arrow) which are the smaller cells that lack the normal central pallor (60x). To view click on
figure
Figure c8-2. RBC agglutination. Clustering of RBCs in variable groups indicates that
agglutination is present. This change is caused by antibody bridging between adjacent RBCs
Figure c8-3. Spherocytes and ghost RBCs are present. The latter indicate some degree of
intravascular lysis (100x). To view click on figure
Figure c8-4. Marked regenerative response is evidenced by marked anisocytosis,

macrocytosis, and polychromasia. Smaller RBCs without central pallor are spherocytes. To
view click on figure
Diagnosis
Immune-mediated hemolytic disease, Coombs' positive.

Outcome
Responded to prednisone therapy.
Case 9
History
Canine 2 Year Old Intact Female Labrador
Forelimb lameness, fever and loss of appetite for 3 weeks. Dog was treated with antibiotics
for 2 weeks with no improvement.
T 105F, pain in right humerus, cough with moist rales, enlarged peripheral lymph nodes. No
evidence of dehydration.
PCV %
Hgb g/dl
RBC x106/ul
MCV fl
MCH pg
MCHC g/dl
TPP g/dl
Plasma color
Reticulocytes %
Absolute Retic/ul
Platelets
Laboratory Data
30
(37 - 55)
WBC/ul
10.2
(12 - 15)
Neutrophils
4.3
(5.5 - 8.5)
Band cells
70
(60 - 77)
Lymphocytes
23
(19 - 24)
Monocytes
34
(32 - 36)
Eosinophils
8.8
6.0 - 7.5)
Normal
0.9
(<1.0)
38,700 (<80,000)
ADQ
RBC Morphology:
Patient
46,300
42,133
926
926
1,852
463
Reference Range
(6000 - 17,000)
(3,000 - 11,400)
(0 - 300)
(1,000 - 4,800)
(150 - 1,350)
(100 - 750)
Normal
Mild anemia is evident with increased total protein concentration. Anemia is normocytic and
normochromic (Fig. c9-1). Physical examination reveals no evidence of hemorrhage.
Reticulocyte count and RBC morphology indicate no evidence of regeneration, which should
be expected with hemorrhage or hemolysis and a 3 week history of disease. The increase in
total protein can be due to dehydration or increased globulin synthesis in response to
infection/inflammation. Since there is no evidence of dehydration, hyperglobulinemia is the
likely cause. The WBC count is increased due to a moderate to marked neutrophilia with a
monocytosis and a minimal left shift (2% of the WBCs in the differential count are band
neutrophils). These findings are consistent with chronic inflammation. The decrease in
lymphocyte numbers is due to endogenous glucocorticoid release or stress response.
The bone marrow was cellular with an increased myeloid:erythroid (M:E) ratio (Fig. c9-2).
Granulopoiesis was active with normal maturation. Erythroid precursors were reduced in
number but maturation appeared normal. Marrow iron stores were increased.
Figure c9-1. Canine blood. Normocytic, normochromic RBCs indicate that the anemia is
nonregenerative. Segmented neutrophil and monocyte are in the field. Neutrophilia and
monocytosis indicated chronic inflammation with tissue necrosis (100x). To view click on
figure
Figure c9-2. Bone marrow. Granulocytic hyperplasia and erythroid hypoplasia are evident in
the marrow smear. The majority of cells are developing granulocytes with a marked reduction
in erythroid activity. The CBC and marrow changes are consistent with chronic inflammation
Summary
Nonregenerative anemia, hyperglobulinemia, and neutrophilic leukocytosis with minimal left

shift and monocytosis. Bone marrow has increased iron stores and a predominance of
granulocytic cells with a reduction in erythroid precursors indicating granulocytic hyperplasia
and erythroid hypoplasia. These findings are consistent with anemia of inflammation.
Outcome
Fine needle aspirate of lymph nodes and lung reveal pyogranulomatous inflammation due
Blastomyces dermatitidis (Fig. c9-3).
Figure c9-3. Aspirate of lymph node. Pyogranulomatous inflammation is present in the node.
Majority of cells are neutrophils and macrophages with a broad-based budding yeast visible
to the right of center. Morphology of yeast is consistent with Blastomyces dermatitidis. To
view click on figure
Case 10
9 Year Old Neutered Male Gordon Setter
History
Adopted from humane society 1 year ago. Owner has noticed increased hair shedding and
decreased physical activity.
Normal body temperature. Increased pulse rate. Bilaterally symmetrical alopecia with severe
weakness, weight loss, and pale mucous membranes. Abdominal mass detected on abdominal
palpation.
PCV %
Hgb g/dl
RBC x106/ul
MCV fl
MCH pg
MCHC g/dl
TPP g/dl
Plasma color
Reticulocytes %
Absolute Retic/ul
Platelets/ul
Patient
9
3.0
1.3
69
23
33
7.1
Normal
0.8
10,400
43,000
Laboratory Data
Reference Range
(37 - 55)
WBC/ul
(12 - 15)
Neutrophils
(5.5 - 8.5)
Band cells
(60 - 77)
Lymphocytes
(19 - 24)
Monocytes
(32 - 36)
Eosinophils
(6.0 - 7.5)
Patient
3,895
2,804
1,051
39
-
Reference Range
(6,000 - 17,000)
(3,000 - 11,400)
(0 - 300)
(1,000 - 4,800)
(150 - 1,350)
(100-750)
(<1.0)
(<80,000)
(>200,000)
RBC Morphology:
No abnormalities
A severe anemia is present with normal RBC indices and no evidence of regeneration in the
RBC morphology or reticulocyte count (Fig. c10-1). Severe thrombocytopenia, leukopenia,
and neutropenia are present. These findings indicate a severe decrease in circulating blood
cells or pancytopenia. Bone marrow aspiration is indicated.
Bone marrow examination revealed a severely hypocellular marrow with very few erythroid,
granulocytic, or megakaryocytic precursors (Fig. c10-2). An occasional capillary fragment is
noted. Most of the marrow has been replaced with fat tissue.
Figure c10-1. Bone marrow. Replacement of the normal marrow cells with adi- pose tissue
and connective tissue indicates severe marrow hypoplasia. Reduction in marrow activity
results in pancytopenia. This change can be caused by toxins, drugs, infectious agents,
chemical injury, and immune-mediated disease. To view click on figure
Figure c10-2. Canine blood. Severe nonregenerative anemia and thrombocytopenia are
evident. Polychromasia, anisocytosis, and macrocytosis are absent. Platelets are rarely seen
Diagnosis
Severe pancytopenia due to marrow hypoplasia/destruction. Consider toxic chemicals, drugs,

infectious agents, or immune-mediated disease as possible causes.
Outcome
Ultrasound guided FNA of abdominal mass reveals a Sertoli cell tumor. Metastasis is evident
in the regional lymph nodes. These tumors can secrete high levels of estrogen resulting in
symmetrical alopecia and severe marrow hypoplasia. Serum estrogen levels were measured
and levels were extremely high. Because of metastatic disease in the iliac and sublumbar
lymph nodes, the owner elected euthanasia. The owner subsequently discovered that the dog
had not been neutered and was a bilateral cryptorchid.
Case 11
Feline 10 Month Old Female Siamese
History
Straining in an attempt to deliver kittens.

T =104.9F, depressed, dehydrated, serohemorrhagic vaginal discharge; radiographs reveal

macerated fetuses in genital tract.
PCV %
TPP g/dl
Platelets
WBC/ul
Neutrophils
Band cells
Metarubricytes
Lymphocytes
Monocytes
Eosinophils
Toxic neutrophils
Laboratory Data
Patient
Day 1 Day 2 Day 5
46
38
29
7.0
4.6
4.5
ADQ ADQ ADQ
9,500 9,100 48,400
2,755 3,003 45,980
5,415 4,914 1,452
95
273
665
637
484
570
273
484
3+
3+
-
Reference Range
(30 - 40)
(6.0 - 7.5)
(5,500 - 19,500)
(2,500 - 12,500)
(0 - 300)
(1,500 - 7,000)
(0 - 850)
(0 - 750)
Day 1
Polycythemia is due to dehydration. Normal TPP in light of severe dehydration indicates

hypoproteinemia. Leukogram reveals severe degenerative left shift, lymphopenia, and toxic
neutrophils (Figure c11-1, Figure c11-2, and Figure c11-3). These changes are compatible
with overwhelming or peracute inflammation of a well-vascularized tissue or body cavity.

The severity of the left shift (bands exceed mature neutrophils with a normal WBC count)
indicates a poor prognosis. Acute peritonitis or metritis is a likely cause. Hypoproteinemia is
due to protein leakage associated with acute inflammation. Abdominocentesis reveals a
neutrophilic exudate with rod-shaped bacteria (Figure c11-4).
Figure c11-1. Feline blood. Increase in band neutrophils indicates a severe left shift.
Increased rouleaux formation can be caused by changes in plasma proteins as a result of
inflammation (40x). To view click on figure
Figure c11-2. Feline blood. Inflammation can produce changes in neutrophil morphology.
Two segmented neutrophils are present that have a slight increase in cytoplasmic basophilia.
One of the neutrophils is very large and has abnormal nuclear lobulation which is a sign of
toxic change (100x). To view click on figure
Figure c11-3. Feline blood. RBCs are crenated with marked rouleaux formation. Band
neutrophils are extremely toxic with basophilic granular cytoplasm and Dohle bodies (100x).
To view click on figure
Figure c11-4. Abdominal fluid. Mixture of neutrophils and macrophages are present.
Phagocytosed bacteria are noted. These findings confirm septic peritonitis (100x). To view
click on figure
Day 2
Cat was given IV fluids and antibiotics prior to exploratory laparotomy. With rehydration,
PCV is reduced to normal and the hypoproteinemia is evident. Leukocyte values are similar
to day 1 and indicate acute overwhelming inflammation and sepsis. Severe lymphopenia on
both days is due to stress response. Exploratory surgery revealed acute metritis with a uterine
perforation resulting in acute diffuse peritonitis. Ovariohystorectomy and abdominal lavage
were done.
Day 5
CBC is 2 days postoperative and reveals a marked neutrophilic leukocytosis with left shift
and severe lymphopenia. The leukocyte response from day 2 to day 4 is caused by the abrupt
removal of the site of inflammation. A rebound neutrophilia occurs because of continued
production and release of neutrophils from a stimulated bone marrow. Hypoproteinemia
persists and will recover gradually during the next 2 weeks. PCV is reduced due to blood loss
at surgery and the presence of severe inflammation.
Outcome
Uneventful recovery.
Case 12
Canine 1 Year Old Intact Male Collie
History
Severe vomiting and diarrhea for 12 hours.

T= 98F, P 40, 8% dehydration; dog is very weak and nearly comatose.
PCV %
Hgb g/dl
RBC x106/ul
MCV fl
MCH pg
MCHC g/dl
TPP g/dl
Platelets
Patient
60
20.5
8.9
67
23
34
9.3
ADQ
Laboratory Data
Reference Range
(37 - 55)
WBC/ul
(12 - 15)
Neutrophils
(5.5 - 8.5)
Band cells
(60 - 77)
Lymphocytes
(19 - 24)
Monocytes
(32 - 36)
Eosinophils
(6.0 - 7.5)
Patient
11,300
8,136
113
1,928
678
452
Reference Range
(6,000 - 17,000)
(3,000 - 11,400)
(0 - 300)
(1,000 - 4,800)
(150 - 1,350)
(100 - 750)
Polycythemia and hyperproteinemia are due to dehydration. The leukogram reveals a
normal neutrophil and lymphocyte count. The leukocyte response is not indicative of
inflammation or sepsis that would be significant considerations in the differential diagnosis.
With the severity of clinical signs, we would expect at least a stress leukogram. A normal
leukogram with these clinical signs is indicative of diminished levels of adrenal steroids that
are characteristic of acute adrenocortical insufficiency (Addison's disease).
Serum chemistries revealed prerenal azotemia, hyponatremia, hyper- kalemia, and a low
baseline cortisol followed by a minimal response to ACTH stimulation.
Case 13
Canine 1 Year Old Intact Female Boxer
History
Hit by car 2 days prior to admission. Owner noticed that dog was not eating and was
depressed.
Multiple abrasions. Area of pain over entire left side of abdomen.

Laboratory Data
Patient
Day 1 Day 2 (AM) Day 2 (PM)
PCV %
39
36
39
TPP g/dl
6.8
7.3
7.0
Platelets
ADQ ADQ
Decreased
WBC/ul
19,500 13,600
3,800
Neutrophils
17,355 11,520
1,178
Band cells
1,360
1,216
Lymphocytes
390
680
912
Monocytes
780
408
494
Eosinophils
975
Toxic neutrophils 2+
3+
Abdominal Fluid (Day 2)
Color: cloudy, red tinged
TP: 4.7 g/dl
WBC: 23,000/ul
Diff: 93% neutrophils
Reference Range
(37 - 55)
(6.0 - 7.5)
(6,000 - 17,000)
(3,000 - 11,400)
(0 - 300)
(1,000 - 4,800)
(150 - 1,350)
(100 - 750)
Day 1
A neutrophilic leukocytosis and lymphopenia are present. Toxic neutrophils or a left shift
were not observed. These findings are consistent with a stress response. However, an early
(mild) inflammatory response cannot be ruled out.
Day 2 (8AM)
The condition of the dog has deteriorated clinically. Depression, poor capillary refill time,
and a rapid pulse are evident. The number of leukocytes and neutrophils has decreased and
there is a marked left shift with toxic neutrophils (Figure c13-1). Acute inflammation or
sepsis is likely. A careful search for site or organ system involved should be undertaken.
Abdominocentesis revealed a septic neutrophilic exudate indicating acute peritonitis (Figure

c13-2).
Figure c 13-1. Canine blood. Both neutrophils exhibit toxic change in the form of
cytoplasmic basophilia, vacuolation, and Dohle bodies. RBCs are crenated (100x). To view
click on figure
Figure c 13-2. Abdominal fluid. Numerous degenerate neutrophils that contain a mixed
population of phagocytosed bacteria are present in a proteinaceous background. Cytologic
findings confirm septic peritonitis (100x). To view click on figure
Day 2 (3PM)
Diffuse peritonitis was evident on surgical exploration. Multiple segments of infarcted bowel
were resected. A CBC just prior to surgery revealed a marked reduction in neutrophil
numbers with a severe degenerative left shift and toxic neutrophils. This change occurred
over a 7-hour period and is indicative of severe overwhelming inflammation and a very grave
prognosis. The decrease in platelets is likely due to consumption at sites of thrombosis and
infarction. The dog died shortly after the surgery.
This case illustrates the dynamic and abrupt changes that can occur in the leukogram in
response to acute overwhelming inflammation.
Case 14
Feline 10 Year Old Castrated Male Tabby DSH
History
Episodes of vomiting and respiratory distress. Respiratory signs are unresponsive to

antibiotics.
Normal body temperature with increased respiratory rate and expiratory effort. Chest
radiographs reveal several nodular radiopaque densities in the lungs. Moderate dehydration is
present.
PCV%
Hgb g/dl
RBC x106/ul
MCV fl
MCH pg
MCHC g/dl
TPP g/dl
Patient
40
13.1
8.6
46
15.2
33
8.6
Laboratory Data
Reference Range
(30 - 40)
WBC/ul
(8.5 - 15)
Neutrophils
(5.2 - 10)
Band cells
(39 - 55)
Lymphocytes
(13 - 17)
Monocytes
(30 - 36)
Eosinophils
(6.0 - 7.5)
Patient
17,000
6,120
2,040
340
8,500
Reference Range
(5,500 - 19,500)
(2,500 - 12,500)
(0 - 300)
(1,500 - 7,000)
(0 - 850)
(0 - 750)
Increase in PCV and TPP is due to dehydration. Leukocytosis is due to a marked

eosinophilia. Causes include allergy and hypersensitivity reactions, chronic granulomatous
disease, and neoplasms such as mast cell tumors or lymphoma. Eosinophilic leukemia and
hypereosinophilic syndrome are infrequent causes. Parasites that reside in the lung or that
have a significant tissue migration phase or exposure to the immune response are frequent
causes. Allergic or granulomatous diseases of the skin, respiratory tract, female genital tract
or gastrointestinal tract are also likely to produce an eosinophilic leukocytosis. Because of the
respiratory signs, Paragonimus (lung fluke), Aleurostrongylus (nematode), feline heartworm,
and feline asthma were considered. A transtracheal wash revealed numerous eosinophils with
a few macrophages (Figure c14-1). A few large, oval, rust- colored, operculated eggs (Figure
c14-2) were also noted and confirm a diagnosis of Paragonimus infection.
Figure c14-1. Transtracheal wash. Numerous eosinophils are present in the transtracheal wash
indicate allergy, hypersensitivity reaction, respiratory parasites, or possible heartworm
infection (100x). To view click on figure
Figure c14-2. Transtracheal wash. Low power scan of the sample reveals a few yellow oval
Paragonimus eggs. The operculum on the eggs is not visible at this magnification. This lung
fluke causes severe eosinophilic inflammation in the lung and airways (20x). To view click
on figure
Case 15
History
Canine 14 Year Old Intact Female Cocker Spaniel
Dog was presented in a state of acute collapse. The dog resides in a household with numerous
pets and prior history was vague.
The animal is in fair body condition and has a purulent vaginal discharge. T = 98.7F, rapid
pulse, poor capillary refill time, moderate dehydration,and congested mucous membranes.
PCV%
Hgb g/dl
RBC x106/ul
MCV fl
MCH pg
MCHC g/dl
TPP
Platelets
RBC morphology
WBC/uL
Neutrophils
Band cells
Metamyelocytes
Lymphocytes
Monocytes
Toxic neutrophils
Laboratory Data
Patient
Day 1
Day 3
38
31
12.6
10.3
5.6
4.6
68
67
23
22
33
34
6.7
5.2
ADQ
ADQ
Normal
7,700
21,800
3,773
18,748
2,233
436
154
0
1,155
654
308
1,962
2+
-
Reference Range
(37 - 55)
(12 - 18)
(5.5 - 8.5)
(60 - 77)
(19 - 24)
(32 - 36)
(6.0 - 7.5)
(6,000 - 17,000)
(3,000 - 11,500)
(0 - 300)
(1,000 - 4,800)
(150 - 1,350)
Abdominal paracentesis: exudate with degenerate neutrophils and rod- shaped bacteria.
Day 1
The PCV and TPP are at the low end of normal and indicate anemia and hypoproteinemia
when considered in light of moderate dehydration. The leukogram reveals a low normal
WBC count with a severe left shift and toxic neutrophils. This response indicates acute
overwhelming inflammation of a large, well-vascularized tissue or organ. The inflammation
is severe enough to have depleted the marrow storage pool of mature and band neutrophils
and initiate release of metamyelocytes. Causes of this type of response include acute
peritonitis, necrotizing pancreatitis, acute suppurative pneumonia, acute cellulitis, or GI
perforation. A poor prognosis is indicated because the WBC and segmented neutrophils
counts are low, and band neutrophils exceed the number of segmented cells. The site of
inflammation must be identified quickly and steps taken to initiate treatment.
Radiographs and abdominocentesis indicate acute septic peritonitis (Figure c15-1).
Exploratory surgery revealed acute metritis with uterine perforation and peritonitis.
Figure c15-1. Abdominal fluid. Mixture of degenerate and nondegenerate neutrophils with
phagocytosed rod-shaped bacteria indicates septic peritonitis (100x). To view click on figure
Day 3
With rehydration, anemia and hypoproteinemia are apparent. The anemia is likely due to
inflammation and hemorrhage during surgery. Hemorrhage may also cause hypoproteinemia
but leakage of plasma protein associated with diffuse inflammation is a factor in this case. A
moderate leukocytosis with mild left shift and monocytosis is evident. Lymphopenia indicates
stress. These changes are consistent with resolving inflammation and indicate that the bone
marrow has repopulated the maturation pool of mature neutrophils and that the tissue demand
for neutrophils has subsided. The prognosis is much improved.
Outcome
Recovery was uneventful. Reliance on total WBC counts alone in assessing the leukogram
can be misleading. When the dog was in critical condition (Day 1) the total WBC count was
normal. During recovery, the total WBC count was increased. However, the severe left shift
and toxic neutrophils on Day 1 indicated the true magnitude and severity of disease.
Case 16
Feline 9 Year Old Spayed Female Persian
History
Cat has been treated with several drugs for respiratory and uri- nary tract infections.
The cat is depressed, listless, and has pale mucous membranes.
PCV %
Hgb g/dl
RBC x106/ul
MCV fl
MCH pg
MCHC g/dl
TPP g/dl
Platelets/ul
Reticulocytes %
Patient
13
4.2
2.25
57
19
32
7.1
525,000
11
Laboratory Data
Reference Range
(30 - 40)
WBC/ul
(8.5 - 15)
Neutrophils
(5.2 - 10)
Band cells
(39 - 55)
Lymphocytes
(13 - 17)
Monocytes
(30 - 36)
Eosinophils
(6.0 - 7.5)
(>300,000)
(<0.6%)
Patient
17,600
11,440
176
4,752
1,232
-
Reference Range
(5,500 - 19,500)
(2,500 - 12,500)
(0 - 300)
(1,500 - 7,000)
(0 - 850)
(0 - 750)
Laboratory Data
Patient
Reference Range
(<80,000)
Plasma color
Normal
NRBCs
50/100WBC
RBC Morphology:
Anisocytosis, Macrocytosis, Polychromasia 3+
Ghosts 1+
Howell Jolly bodies 2+
Heinz bodies 3+
The cat has a marked regenerative anemia as evidenced by increased MCV, anisocytosis,
polychromasia, reticulocytosis, and increase in NRBCs (Fig. c16-1 and Fig. c16-2). The
normal TPP and physical examination eliminate hemorrhage as a cause. Hemolytic anemia
can be caused by infectious agents such as RBC parasites, immune-mediated disease,
fragmentation, osmotic lysis, and toxins. Heinz bodies indicate oxidative injury due to drugs,
chemicals, plant sources, or metabolic disease (Fig. c16-3 and Fig. c16-4). The presence of
Heinz bodies will falsely elevate the hemoglobin measurement and cause increases in the
MCH and MCHC. With the marked regenerative response, a decrease in MCHC is expected
but the false increase in hemoglobin causes this value to remain within the reference range.
Heinz bodies can be an incidental finding in the cat but when accompanied by marked
regenerative anemia, the history should be re-examined for possible causes of Heinz body
hemolysis. All previous medications were examined and one was found that contained
methylene blue as part of its formulation. This compound is one of several that can cause
Heinz body hemolytic anemia. Other drugs to consider include acetaminophen, benzocaine,
DL methionine, phenazopyridine, and vitamin K3.
Figure c16-1. Feline blood. Anisocytosis, macrocytosis, polychromasia, and several NRBCs
indicate regenerative anemia (40x). To view click on figure
Figure c16-2. Feline blood. Two NRBCs are compared with a small lymphocyte (arrow).
Platelet numbers are adequate and a few macrocytic polychromatophilic RBCs are present
Figure c16-3. Feline blood. Small rounded projections are noted on three RBCs (arrows).
These inclusions are Heinz bodies which are caused by oxidative injury. The regenerative
anemia in this case is due to hemolysis secondary to Heinz body formation (100x). To view
click on figure
Figure c16-4. Feline blood, reticulocyte stain. Reticulocytes are frequent. Both aggregate and
punctate reticulocytes can be seen. Heinz bodies are small rounded turquoise inclusions
(arrows) on the edge of the RBC membrane (100x). To view click on figure
Diagnosis
Drug-induced Heinz body hemolytic anemia.
Case 17
Feline 4 Year Old Intact Female DSH
History
Anorexia, pendulous abdomen; owners believes cat is pregnant.

T=104.3F cat is depressed, dehydrated, and has a serosanguinous vaginal discharge.
PCV %
Hgb g/dl
RBC x106/ul
MCV fl
MCH pg
MCHC g/dl
TPP g/dl
Platelets/ul
Reticulocytes%
Absolute Retic/ul
Plasma color
Toxic neutrophils
Normal
Laboratory Data
Reference Range
(30 - 40)
WBC/ul
(8.5 - 15)
Neutrophils
(5.2 - 10)
Band cells
(39 - 55)
Metamyelocytes
(13 - 17)
Lymphocytes
(30 - 36)
Monocytes
Eosinophils
8.1
(6.0 - 7.5)
410,000 (>300,000)
0.3
(<0.6%)
19,800 (<80,000)
Normal
1+
RBC Morphology:
Patient
28
9.9
6.6
42
15
33
Patient
123,600
86,520
22,248
3,708
8,652
2,472
-
Reference Range
(5,500 - 19,500)
(2,500 - 12,500)
(0 - 300)
(0)
(1,500 - 7,000)
(0 - 850)
(0 - 750)
In light of clinical dehydration, the cat is normoproteinemic and is more anemic than the
measured PCV would indicate. The anemia is mild and appears nonregenerative because of
the normal reticulocyte count and RBC morphology. There is a marked leukocytosis due to a
neutrophilia, pronounced left shift, lymphocytosis and monocytosis. Dohle bodies in
neutrophils indicate toxic change. This leukogram is consistent with either chronic
granulocytic leukemia or chronic inflammation that involves a major organ or body cavity.
The latter was confirmed by abdominal radiographs which revealed pyometra. The decrease
in PCV is due to the anemia of inflammation.
The marked leukocyte response in this case was caused by chronic suppuration. This pattern
is called a leukemoid reaction since the hematologic features are very similar to chronic
granulocytic leukemia. Large internal abscesses, suppurative pyoderma, or suppuration of
body cavities are frequent causes.
Diagnosis
Pyometra with leukemoid reaction and anemia of inflammation.
Case 18
Canine 10 Year Old Female Sheltie
History
Depression, anorexia, pot-bellied abdomen.

Normal body temperature, increased pulse, pale mucous membranes, large abdominal mass,
marked weight loss.
Patient
PCV %
Hgb g/dl
RBC x106/ul
MCV fl
MCH pg
MCHC g/dl
19
5.6
2.8
68
20
34
TPP g/dl
Plasma color
Reticulocytes %
6.4
Normal
0.2
Laboratory Data
Reference Range
(37 - 55)
WBC/ul
(12 - 15)
Neutrophils
(5.5 - 8.5)
Band cells
(60 - 77)
Metamyelocytes
(19 - 24)
Myelocytes
(32 - 36)
Lymphocytes
Monocytes
Eosinophils
Blasts
(6.0 - 7.5)
(<1.0)
Patient
134,000
64,320
48,240
8,040
1,340
8,040
2,680
Few
Reference Range
(6,000 - 17,000)
(3,000 - 11,400)
(0 - 300)
(0)
(0)
(1,000 - 4,800)
(150 - 1,350)
(100 - 750)
Laboratory Data
Patient
Reference Range
(<80,000)
Platelets/uL
23,000
(>200,000)
NRBC
3/100WBC
RBC Morphology:
Normal
A severe thrombocytopenia and normocytic normochromic anemia are present. A marked

neutrophilic leukocytosis is present with a severe left shift that includes metamyelocytes and
myelocytes. Toxic change was not evident but blast cells that appeared to be granulocytic
precursors were detected (Fig. c18-1 and Fig. c18-2). Lymphocytes and monocytes are
increased. In an intact female dog, the leukocyte pattern could be indicative of chronic
inflammation as would occur in a closed pyometra. The severe anemia, thrombocytopenia,
and excessive number of immature neutrophils are strong indication for bone marrow
aspiration. The abdominal mass was a very large spleen. The bone marrow and spleen
aspirates were diffusely infiltrated by large blast cells and developing neutrophil precursors
(Fig. c18-3 and Fig. c18-4). Megakaryocytes and erythroid precursors were rare. Similar cells
were detected in aspirates of lymph node. These findings confirmed a diagnosis of chronic
granulocytic leukemia.
Diagnosis
Chronic granulocytic leukemia. The leukocyte pattern is similar to that which is found in
dogs with extensive suppurative inflammation. However, in chronic granulocytic leukemia, a
disproportionate number of immature neutrophils is often noted along with severe anemia and
thrombocytopenia due to myelophthisis.
Figure c18-1. Canine blood. Marked leukocytosis due to a neutrophilia and a population of
large round cells that are difficult to identify at this magnification (40x). To view click on
figure
Figure c18-2. Canine blood. Segmented neutrophils are present but there is a disproportionate
number of immature granulocytes present with indented, lobulated, or rounded nuclei. One of
the larger cells is a blast form and has multiple nucleoli. RBCs are normocytic and
normochromic indicating a nonregenerative anemia. Platelets are markedly reduced. These
findings are consistent with chronic granulocytic leukemia (100x). To view click on figure
Figure c18-3. Bone marrow. The marrow is cellular and contains numerous large immature
granulocytes and mature neutrophils. Erythroid and megakaryocytic precursors are rare (40x).
To view click on figure
Figure c18-4. Bone marrow. Higher magnification reveals an abundance of blast cells that
have a light blue cytoplasm, round or elongate nucleus, and prominent nucleoli. Toxic change
is not apparent in either blood or bone marrow neutrophils (100x). To view click on figure
Case 19
Feline 4 Year Old Male DSH
History
Loss of appetite and lethargy for 3 days.

T=104F, pale mucous membranes, mild dehydration.
PCV %
Hgb g/dl
RBC x106/ul
MCV fl
MCH pg
MCHC g/dl
TPP g/dl
Platelets/ul
Reticulocytes %
Absolute Retic/ul
Plasma color
NRBC
Patient
19
5.8
2.9
67
14
31
7.9
ADQ
9.0
279,900
Icteric
46/100WBC
Laboratory Data
Reference Range
(30 - 40)
WBC/ul
(8.5 - 15)
Neutrophils
(5.2 - 10)
Band cells
(39 - 55)
Lymphocytes
(13 - 17)
Monocytes
(30 - 36)
Eosinophils
(6.0 - 7.5)
(>300,000)
(<0.6%)
(<80,000)
RBC Morphology:
Anisocytosis 3+
Macrocytosis 2+
Patient
7,100
3,479
71
3,124
426
-
Reference Range
(5,500 - 19,500)
(2,500 - 12,500)
(0 - 300)
(1,500 - 7,000)
(0 - 850)
(0 - 750)
Patient
Laboratory Data
Reference Range
Polychromasia 3+
Howell Jolly Bodies 2+
Agglutination 2+
Numerous Haemobartonella felis
A severe regenerative anemia is present with a slightly increased TPP. The regenerative
response is orderly and proportional to the severity of anemia and is characterized by
anisocytosis, macrocytosis, increased MCV, polychromasia, reticulocytosis, and
metarubricytosis (Fig. c19-1). The absence of hypoproteinemia and clinical hemorrhage, and
the presence of an intense regenerative response, icteric plasma, and agglutination are
consistent with hemolytic anemia. Causes of hemolytic anemia include infectious agents,
immune-mediated disease, toxins, fragmentation, and osmotic lysis. The identification of
numerous H. felis organisms on erythrocytes (Fig. c19-2) coupled with the regenerative
response confirms a diagnosis of Haemobartonellosis. These parasites initiate immunemediated destruction of RBCs which frequently results in a positive direct Coombs' test.
Figure c19-1. Feline blood. Marked polychromasia, anisocytosis, and macrocytosis indicate
regenerative anemia. Small basophilic coccoid or rod- shaped organisms are noted on the
RBCs. A few ring forms with a light central area can be seen on a few RBCs. These
organisms are Haemobartonella felis which causes a hemolytic anemia (100x). To view click
on figure
Figure c19-2. Feline blood. In a thin area of the smear, the ring forms of the parasite are
visible in small chains or groups on the RBC membrane (100x). To view click on figure
The number of organisms on the smear can change dramatically from day to day. Thus, if the
parasite is suspected, repeated examinations of blood films may be necessary to make a
diagnosis. Organisms may detach from erythrocytes if there is a time delay between blood
collection and preparation of the blood film. Detached organisms may aggregate at the
feather edge of the smear.
Case 20
Canine 9 Year Old Female Golden Retriever
History
Weakness, lethargy, weight loss for 5 weeks.

Dog is alert but very weak; pale mucous membranes, enlarged liver and spleen, systolic heart
murmur.
PCV %
Hgb g/dl
RBC x106/ul
MCV fl
MCH pg
MCHC g/dl
TPP g/dl
Plasma color
Reticulocytes %
Absolute Retic/ul
Platelets/uL
Patient
11
3.8
1.7
64
24
35
Laboratory Data
Reference Range
(37 - 55)
WBC/ul
(12 - 15)
Neutrophils
(5.5 - 8.5)
Band cells
(60 - 77)
Lymphocytes
(19 - 24)
Monocytes
(32 - 36)
Eosinophils
Blasts
(6.0 - 7.5)
Patient
5,800
812
3,248
232
1,508
Reference Range
(6,000 - 17,000)
(3,000 - 11,400)
(0 - 300)
1,000 - 4,800)
(150 - 1,350)
(100 - 750)
7.2
Normal
0.5
(<1.0)
8,500
(<80,000)
19,000 (>200,000)
RBC Morphology:
No abnormalities
The anemia is normocytic and normochromic with an absence of reticulocytosis or

polychromasia (Fig. c20-1). These features indicate that the anemia is nonregenerative. The
combination of severe nonregenerative anemia, thrombocytopenia, and neutropenia is called
pancytopenia. The neutropenia is not accompanied by a left shift. Causes of this hematologic
pattern include infectious agents, marrow injury due to toxins or drugs, immune-mediated
disease, and neoplasia. Bone marrow aspiration is indicated because of the pancytopenia and
the blast cells identified in the differential count (Fig. c20-1 and Fig. c20-2). The marrow
aspirate was very cellular and contained a homogenous population of blast cells similar to
those in blood (Fig. c20-3). These cells were very large and had dark blue cytoplasm, round
or indented nuclei, and singular prominent nucleoli. Erythroid, megakaryocytic, or
granulocytic precursors were rare.
Figure c20-1. Canine blood. Severe anemia, leukopenia and thrombocytopenia. The RBC are
normocytic and normochromic indicating nonregenerative anemia.Several large
hyperchromatic blast cells were noted and are especially obvious when compared with a
neutrophil (100x). To view click on figure
Figure c20-2. Canine blood. Large blast cell has dark blue cytoplasm, round eccentric
nucleus, multiple nucleoli, and focal cytoplasmic clear zone (100x). To view click on figure
Figure c20-3. Bone marrow. The marrow has been effaced by a homogeneous population of
blast cells similar to those in peripheral blood. Normal marrow precursors are infrequent.
Although this acute leukemia has over- populated the marrow, very few of the blast cells
were noted in the CBC (100x). To view click on figure
Diagnosis
Acute leukemia. Spleen and liver were diffusely infiltrated with blast cells.
Case 21
Canine 2 Year Old Standard Poodle
History
Seems to be short of breath and listless. No clinical evidence of dehydration.

Normal temperature, rapid pulse (110/minute), mucous membranes are brick red, congested,
and sometimes cyanotic. Retinal, scleral, sublingual, and jugular veins are very large and
engorged.
Patient
PCV %
Hgb g/dl
RBC x106/ul
MCV fl
MCH pg
MCHC g/dl
TPP g/dl
Plasma color
Reticulocytes %
Platelets/uL
78
25.7
12.0
65
20
33
7.5
Normal
180,000
Laboratory Data
Reference Range
(37 - 55)
WBC/ul
(12 - 15)
Neutrophils
(5.5 - 8.5)
Band cells
(60 - 77)
Lymphocytes
(19 - 24)
Monocytes
(32 - 36)
Eosinophils
(6.0 - 7.5)
(<1.0)
(>200,000)
Patient
10,300
6,180
2,781
721
618
Reference Range
(6,000 - 17,000)
(3,000 - 11,400)
(0 - 300)
1,000 - 4,800)
(150 - 1,350)
(100 - 750)
Patient
2/100WBC
NRBC
Laboratory Data
Reference Range
Patient
Reference Range
RBC Morphology:
Anisocytosis 1+
Polychromasia 1+
A PCV of 78% in the absence of severe dehydration indicates an absolute polycythemia.

Absolute polycythemias are classified as primary or secondary according to the cause or
mechanism. Primary polycythemia is a myeloproliferative disorder or neoplasm characterized
by excessive production of mature RBCs, normal arterial oxygen content, and normal or
decreased erythropoietin levels. Secondary polycythemias are caused by hypoxemia which
leads to increased erythropoietin levels. Secondary polycythemias can also be caused by
excess production of erythropoietin in the absence of hypoxemia. The latter is quite rare and
occurs with tumors, cysts, or space-occupying lesions of the kidney, liver, or adrenal. Chest
radiographs of the Poodle revealed a pumpkin-shaped cardiac silhouette. Severe hypoxemia
was confirmed by the arterial blood gas analysis (P02 = 32 mmHg, reference range 85-95
mmHg). Angiography revealed a large interventricular septal defect that allowed right to left
shunting of blood. Hypoxemia resulted because a large portion of systemic venous blood
bypassed the lungs. The reduced arterial oxygen content was detected by receptors in the
kidney that initiated an increase in erythropoietin. This hormone is the primary stimulus for
marrow erythroid hyperplasia (Fig. c21-1).
Figure c21-1. Bone marrow. The severe polycythemia in this dog is caused by overproduction
of RBCs in the marrow. This is confirmed by the marked erythroid hyperplasia that is
evident. The maturation is orderly and there is no evidence of neoplasia. Chronic hypoxemia
caused increased erythropoietin secretion which resulted in polycythemia (40x). To view
click on figure
Diagnosis
Absolute polycythemia secondary to hypoxemia due to cardiac defect.
Case 22
History
Canine 6 Year Old Male English Bull Dog
Prior history of otitis which responded to treatment. Mild anemia and increase in TPP noted
at that time. Presented 3 months later with enlarged peripheral lymph nodes and decreased
activity level.
Weight loss and enlargement of all palpable lymph nodes; normal body temperature; no
evidence of dehydration.
PCV %
Hgb g/dl
RBC x106/ul
MCV fl
MCH pg
MCHC g/dl
TPP g/dl
Plasma color
Reticulocytes %
Absolute Retic/ul
Platelets/uL
Laboratory Data
30
(37-55)
WBC/ul
10.2
(12-15)
Neutrophils
4.5
(5.5-8.5)
Band cells
67
(60-77)
Lymphocytes
20
(19-24)
Monocytes
34
(32-36)
Eosinophils
10
(6.0-7.5)
Normal
0.5
(<1.0)
22,500 (<80,000)
ADQ
(>200,000)
RBC Morphology:
Patient
13,800
11,454
---690
1,380
138
Reference Range
(6,000-17,000)
(3,000-11,400)
(0-300)
1,000-4,800)
(150-1,350)
(100-750)
No abnormalities
A mild normocytic, normochromic anemia is present with no evidence of regeneration. PCVs

in Bull Dogs fall in the upper end of the reference range because they are a brachycephalic
breed. The absence of dehydration suggests that the hyperproteinemia is due to
hyperglobulinemia. The PCV and TPP values are similar to previous measurements indicating
that these changes are persistent. The leukogram suggests a stress response or mild
inflammation. Atypical lymphocytes were not detected on the blood films. Basophilic
background on the blood film is consistent with hyperproteinemia (Fig. c22-1). Fine needle
aspiration of lymph nodes and protein electrophoresis are indicated.
Figure c22-1. Canine Blood. Marked hyperproteinemia produces a heavy blue background
that highlights the cell membranes of the RBCs. RBC morphology does not reveal any
evidence of regeneration. Platelets are reduced (100x). To view click on figure
Causes of generalized lymph node enlargement include lymphoma, systemic infection, and
immune-mediated disease. The lymph node aspirate revealed a homogenous population of
large lymphoblasts and confirmed a diagnosis of lymphoma. Bone marrow aspiration
revealed a similar infiltrate (Fig. c22-2). A monoclonal gammopathy was evident in the serum
protein electrophoresis and was responsible for the hyperproteinemia. Lymphoid neoplasms
may produce very high levels of a single immunoglobulin which causes a monoclonal peak in
the electrophoresis. Most dogs with lymphoma do not have significant hematologic
abnormalities. The most frequent changes are mild nonregenerative anemia and a mature
neutrophilia. Both changes are due to the presence of a neoplasm. An absolute lymphocytosis
in canine or feline lymphoma is an infrequent occurrence.
Figure c22-2. Bone marrow. Normal granulopoietic and erythroid cells have been replaced by
a population of large lymphoblasts that have singular prominent nucleoli (100x). To view
click on figure
Diagnosis
Lymphoma with monoclonal gammopathy.
Case 23
Canine 9 Year Old Castrated Male Mixed Breed
History
Treated for anemia with hematinics for 2 weeks. Moderate weight loss. Anorexia and
profound weakness for 2 days. Distended abdomen.
Normal body temperature; pale mucous membranes and rapid respiration. Abdominocentesis
reveals a large amount of bloody fluid. Dog is very weak and collapsed.
Patient
PCV %
Hgb g/dl
RBC x106/ul
MCV fl
MCH pg
MCHC g/dl
TPP g/dl
Plasma color
Reticulocytes %
Absolute Retic/ul
Platelets/uL
22
6.8
2.68
79
25
31
5.1
Normal
19
509,000
99,000
Laboratory Data
Reference Range
(37 - 55)
WBC/ul
(12 - 18)
Neutrophils
(5.5 - 8.5)
Band cells
(60 - 77)
Lymphocytes
(19 - 24)
Monocytes
(32 - 36)
Eosinophils
(6.0 - 7.5)
(<1.0)
(<80,000)
(>200,000)
Patient
28,100
23,323
562
1,124
3,091
-
Reference Range
(6,000 - 17,000)
(3,000 - 11,400)
(0 - 300)
1,000 - 4,800)
(150 - 1,350)
(100 - 750)
NRBC
Patient
28/100WBC
Laboratory Data
Reference Range
RBC Morphology:
Anisocytosis, Polychromasia, Poilkilocytosis 3+
Macrocytosis, Acanthocytosis 2+
Schistocytes, Howell Jolly bodies 1+
A marked regenerative anemia is present as evidenced by anisocytosis, polychromasia,

reticulocytosis, metarubricytosis, and an increase in MCV and a decrease in MCHC.
Hypoproteinemia, the absence of icterus, and the abdominal hemorrhage confirm blood loss
anemia of several days duration. A coagulation profile revealed a moderate increase in
prothrombin time, partial thromboplastin time, and fibrin degradation products. These
changes along with moderate thrombocytopenia and schistocytes (Fig. c23-3) indicate the
presence of disseminated intravascular coagulation. The leukogram reveals a moderate
neutrophilia, mild left shift, and monocytosis that are consistent with inflammation and tissue
necrosis. Acanthocytes are numerous on the blood film (Fig. c23-1 and Fig. c23-2) and are
frequently associated with hemangiosarcoma in the liver. The CBC results, history, and
abdominal hemorrhage are compatible with hemangiosarcoma.
Figure c23-1. Canine blood. Anisocytosis, polychromasia, and macrocytosis indicate

regenerative anemia. Marked poikilocytosis is due to the presence of numerous acanthocytes.
These RBCs have irregular membrane projections that have variable lengths and rounded
points. Platelet numbers are reduced (100x). To view click on figure
Figure c23-2. Canine blood. Numerous acanthocytes and spheroechinocytes are present.
Acanthocytes in a dog with anemia and thrombocytopenia suggest that hepatic involvement
with hemangiosarcoma should be considered (100x). To view click on figure
Figure c23-3. Canine blood. Marked thrombocytopenia and the presence of several
schistocytes or fragmented RBCs are indications that thrombosis or DIC is occurring.
Coagulation tests are indicated (100x). To view click on figure
Diagnosis
Hemorrhagic anemia and DIC with inflammatory leukogram. Exploratory surgery was done.
A ruptured splenic hemangiosarcoma with numerous metastatic lesions in the liver was
detected.
Case 24
Canine 9 Year Old Spayed Female Corgi
History
Bloody urine and weakness for 5 days.

Mucous membranes are pale and melena is present. Numerous petechial hemorrhages.
Abdomen is painful on palpation.
Laboratory Data
PCV %
24
(37 - 55)
WBC/ul
Hgb g/dl
8.4
(12 - 18)
Neutrophils
6
RBC x10 /ul
2.67
(5.5 - 8.5)
Band cells
MCV fl
90
(60 - 77)
Lymphocytes
MCH pg
31.5
(19 - 24)
Monocytes
MCHC g/dl
34
(32 - 36)
Eosinophils
TPP g/dl
5.0
(6.0 - 7.5)
Plasma color
Normal
Reticulocytes %
8
(<1.0)
Absolute Retic/ul
480,600 (<80,000)
Platelets/uL
3,000
(>200,000)
NRBC
34/100WBC
RBC Morphology:
Anisocytosis, polychromasia, macrocytosis 3+
Patient
44,900
34.124
4,939
898
3,143
1,347
Reference Range
(6,000 - 17,000)
(3,000 - 11,400)
(0 - 300)
(1,000 - 4,800)
(150 - 1,350)
(100 - 750)
Macrocytosis, reticulocytosis, polychromasia, metarubricytosis, and anisocytosis indicate

regenerative anemia. Hypoproteinemia, hematuria, petechiation, and melena indicate that the
anemia is due to hemorrhage as a result of the severe thrombocytopenia (Fig. c24-1).
Hemolytic anemia is also a possibility. A neutrophilic leukocytosis with left shift and
monocytosis indicate inflammation with possible tissue necrosis. Lymphopenia is due to
stress. The eosinophilia if persistent is an indication of hypersensitivity. A coagulation profile
(PT, PTT, FDP) was normal. Direct Coombs'; test and titers for Ehrlichia, Lyme disease, and
Rocky Mountain Spotted Fever were negative.
Figure c24-1. Canine blood. Regenerative anemia and thrombocytopenia are pronounced. The
large round granular structure in the center is a giant platelet. Large shreds of megakaryocyte
cytoplasm are often found in severely thrombocytopenic animals (100x). To view click on
figure
Aspiration of bone marrow is indicated to assess thrombopoiesis. The marrow was very
cellular and revealed an increase in immature and mature megakaryocytes (Fig. c24-2).
Erythroid hyperplasia was also noted. These findings indicate that the thrombocytopenia was
due to excessive destruction rather than reduced production.
Figure c24-2. Bone marrow. Bone marrow examination is helpful in the assessment of
thrombocytopenic animals. In this marrow there are numerous megakaryocytes in the field
indicating that the decrease in platelets is due to accelerated destruction rather than decreased
production (25x). To view click on figure
Diagnosis
Presumptive immune-mediated thrombocytopenia. Dog was treated successfully with

predisone and azothioprine.
Case 25
Canine 11 Year Old Spayed Female Basset Hound
History
Dog presented for suture removal and recheck following a splenectomy that was done 8 days
ago. Hemoperitoneum and a large splenic hematoma were noted during laparotomy. PCV at
the time of surgery was 25%.
Abdominal incision is healing normally. TPR is normal. Mucous membranes are pink with
normal capillary refill.
PCV %
Hgb g/dl
Laboratory Data
30
(37 - 55)
WBC/ul
10.7
(12 - 18)
Neutrophils

7,000
(6,000 - 17,000)
5,600
(3,000 - 11,400)
RBC x10 /ul

MCV fl
MCH pg
MCHC g/dl
TPP g/dl
Plasma color
Reticulocytes %
Absolute Retic/ul
Platelets/uL
Patient
4.9
62
22
35
7.0
Normal
1.3
63,700
ADQ
Laboratory Data
Reference Range
(5.5 - 8.5)
Band cells
(60 - 77)
Lymphocytes
(19 - 24)
Monocytes
(32 - 36)
Eosinophils
(6.0 - 7.5)
Patient
630
560
140
Reference Range
(0 - 300)
(1,000 - 4,800)
(150 - 1,350)
(100 - 750)
(<1.0)
(<80,000)
(>200,000)
RBC Morphology:
Polychromasia 1+
The leukogram is unremarkable except for a lymphopenia that is due to stress. A mild,
normocytic, normochromic anemia is present with a minimal reticulocyte response. These
findings indicate that the regenerative response is either inadequate or subsiding as the PCV
approaches normalcy. Examination of the blood film is indicated in all anemic animals.
Erythrocytes need to be examined for size, shape, color, and inclusions. Examination of the
blood film revealed moderate numbers of coccoid, basophilic, epicellular RBC parasites (Fig.
c25-1). Many of the organisms were arranged in chains that branched. The morphology of the
organisms was consistent with Haemobartonella canis.
Figure c25-1. Canine blood. Chains of basophilic small coccoid organisms are noted on the
surface of two RBCs. Haemobartonella canis causes a mild to moderate hemolytic anemia in
dogs that have been splenectomized or treated with immunosuppressive drugs. To view click
on figure
H. canis causes mild anemia due to extravascular hemolysis in dogs that have been
splenectomized or in those that have received glucocorticoids, chemotherapy, or
immunosuppressive drugs. The organism can be transmitted by blood transfusion or by biting
arthropods. This dog received a blood transfusion during surgery and the donor was
subsequently identified as an infected carrier.
Diagnosis
Mild anemia due to Haemobartonella canis. Dog was treated with tetracycline and made an
uneventful recovery.
Case 26
Feline 7 Year Old Male Domestic Shorthair
History
Owner reports that the cat drinks a lot of water and has been losing weight. Appetite is
diminished.
Cat is depressed, mildly dehydrated, and in poor body condition.
PCV %
Hgb g/dl
RBC x106/ul
MCV fl
MCH pg
MCHC g/dl
TPP g/dl
Plasma color
Platelets/ul
Reticulocytes %
Absolute Retic/ul
Plasma color
Patient
20
6.8
4.0
50
17
34
7.9
Normal
ADQ
0.4
16,000
Normal
Laboratory Data
Reference Range
(30 - 40)
WBC/ul
(8.5 - 15)
Neutrophils
(5.2 - 10)
Band cells
(39 - 55)
Lymphocytes
(13 - 17)
Monocytes
(30 - 36)
Eosinophils
(6.0 - 7.5)
Patient
8,000
7,200
560
240
-
Reference Range
(5,500 - 19,500)
(2,500 - 12,500)
(0 - 300)
(1,500 - 7,000)
(0 - 850)
(0 - 750)
(>300,000)
(<0.6%)
(80,000)
RBC Morphology:
Few Heinz bodies

The CBC reveals a moderate, normocytic, normochromic anemia with no evidence of

regeneration. Hyperproteinemia is due to dehydration. The leukogram reveals a marked
lymphopenia which can be due to stress or to loss or sequestration of lymphocytes. Examples
of the latter include chylous effusions or protein-losing enteropathy. Absence of GI signs and
negative chest radiograph eliminates these causes. Examination of the blood film did not
reveal significant abnormalities.
A bone marrow aspirate revealed a cellular marrow with an increased M:E ratio, normal iron
stores, and adequate megakaryocytes. Maturation in granulocytes and in the limited number
of erythroid cells was normal. In light of the normal neutrophil count and the moderate nonregenerative anemia, the M:E ratio is increased due to decreased erythroid activity rather than
increased granulopoiesis (Fig. c26-1). Causes of erythroid depression need to be considered.
Serum chemistry results indicate severe azotemia (urea=205 mg/dl, creatinine=11.9 mg/dl).
Isosthenuria and severe proteinuria with an inactive sediment were noted in the urinalysis.
The azotemia and urine specific gravity were unaffected by fluid therapy and diuresis. These
findings are consistent with chronic renal disease with severe proteinuria. The anemia is due
to diminished erythropoietin production which causes decreased RBC production in the bone
marrow. In the absence of a regenerative anemia or certain metabolic disorders, Heinz bodies
are considered an incidental finding.
Figure c26-1. Feline bone marrow. In nonregenerative anemias, bone marrow assessment is
extremely valuable in deciding the cause or mechanism. In this cat, diminished erythropoietin
levels as a result of renal disease lead to erythroid hypoplasia. Therefore the M:E ratio is
increased in the marrow due to a reduction in erythroid cells relative to the granulocytes
Diagnosis
Nonregenerative anemia due to chronic renal disease (renal amyloidosis).
Case 27
Canine 12 Year Old Mixed Breed Male
History
Male dog was admitted to the hospital 4 days ago for elective castration due to benign
prostatic hypertrophy. There was no palpable tumor but the prostate was symmetrically
enlarged and the dog was having difficulty urinating and defecating. He had previously been
in excellent health and had an unremarkable medical history. He had no past history of
bleeding. Surgery had been uneventful but petechiae and ecchymoses on the ventral abdomen
were noted four days postoperatively.
Laboratory Data
PCV %
44
(37 - 55)
WBC (corrected) /ul
Hb g/dl
14
(12 - 18)
Neutrophils
RBC x106/ul
6.2
(6 - 8)
Band cells
MCV fl
71
(60 - 77)
Lymphocytes
MCHC g/dl
34
(31 - 35)
Monocytes
MCH pg
22.5
(19 - 24)
Eosinophils
Basophils
TPP g/dl
7.3
(6.0 - 8.0)
Platelets/ul
35,000 (200 - 400)
Platelet morphology Some oval, large
Coagulation Tests
Patient
Reference Range
Thrombin time (TT) sec
12
(12 - control)
PT sec
11
(12 - control)
APTT sec
18
(18 - control)
PT is Prothrombin Time; APTT is Activated Partial
Thromboplastin Time. With coagulation tests, patient values
differing by more than 30% of the control value are

2,200 (6,000 - 17,500)
800
(3,000 - 11,500)
0
(0 - 400)
1,200 (1,000 - 4,800)
200
(150 - 1,350)
0
(100 - 1,250)
0
(0)
Coagulation Tests
considered significant.
Patient
Reference Range
The hemogram reveals severe thrombocytopenia and leukopenia. The leukopenia is

characterized by neutropenia. Because a left shift is not present, the neutropenia is most likely
due to a problem in marrow production. Tests of secondary hemostasis, coagulation appear
appropriate.
Causes of concurrent neutropenia and thrombocytopenia should be considered. In light of the
patient's recent history and the acuteness of this presentation, drug and infectious etiologies
should be considered. While awaiting the results of rickettsial serologic tests, appropriate
antimicrobial therapy should be initiated, especially considering this patient's significant
neutropenia. Bone marrow examination should be considered.
This patient was no longer receiving drugs at the time of this presentation. Ehrlichia titers
were markedly elevated. The patient responded well to appropriate therapy. This is an
example of immune-mediated thrombocytopenia secondary to an infectious process.
Case 28
Canine 7 Year Old Mixed Breed Spayed Female
History
An urgent consultation was requested for a patient in the intensive care unit. This dog had
returned from surgery following extensive bowel resection for sarcoma. During surgery she
was autotransfused from vacuumed abdominal blood. Over the 24 hour postoperative period
she had received three units of crossmatch compatible whole blood (of the same blood type
as hers) for extensive intraoperative and postoperative blood loss. Following surgery,
continued bleeding followed by oozing was observed from the abdominal drain tube and
following venipuncture. There was no previous history of bleeding and a hemostatic profile
performed 24 hours presurgically was similar to control values. Petechiae and purpura were
noted on the lower limbs. Chest radiographs were normal and blood culture was negative.
Patient
PCV %
22
Hb g/dl
7.6
RBC x106/ul
3.2
MCV fl
65
MCHC g/dl
31.5
MCH pg
20
Reticulocytes % 0
TPP g/dl
5.7
Fibrinogen mg/dl 200
Laboratory Data
Reference Range
(37 - 55)
WBC (corrected)/ul
(12 - 18)
Neutrophils
(6 - 8)
Band cells
(60 - 77)
Lymphocytes
(31 - 35)
Monocytes
(19 - 24)
Eosinophils
(0 - 1.5)
Basophils
(6.0 - 8.0)
(200 - 400)

10800 (6,000 - 17,500)
7750 (3,000 - 11,500)
750
(0 - 400)
1300 (1,000 - 4,800)
900
(150 - 1,350)
100
(100 - 1,250)
0
(0)
Laboratory Data
Patient
Reference Range
Platelets/ul
23,000
(200,000 - 400,000)
NRBC
4/100WBC
Morphology:
RBC Poik/leptocytes
WBC Toxic neutrophils
Platelet Many large
Coagulation Tests
Patient
Reference Range
Thrombin time (TT) sec
20
(12 - control)
PT sec
19
(12 - control)
APTT sec
31
(18 - control)
FDP ug/ml
0
(<10)
Antithrombin III %
71
(>85)
D-dimers
10
(0)
D-dimers are specific fibrin(ogen) degradation products using
a canine specific test.
This patient appears to have an acute blood loss anemia which is severe, normocytic,
normochromic and nonresponsive. The presence of nucleated red cells, in this case
metarubricytes, may be considered an acute response. There is a marked reduction in plasma
proteins when considering both the reference interval and the patient's age (older dogs have
higher total protein concentrations than younger dogs). The platelet count is markedly
reduced. The presence of large platelets may be an acute and positive response to the patient's
thrombocytopenia. This patient is in DIC. DIC is always secondary to a significant primary
process. The possibilities of inducing DIC in this patient include the surgical trauma, the
presence of neoplasia, and the possibility, despite all efforts, of a transfusion reaction.
Case 29
Canine 5 Year Old Mixed Breed Intact Male
History
At 2100 hours this patient was bitten on his left forepaw, around the toes, by Crotalus atrox,
the Western Diamond Back rattlesnake. He was brought to an emergency clinic within 40
minutes. There he was noted to have pain and swelling limited to the left front leg, mostly the
paw region. Vital signs were normal. The leg was immobilized and an intravenous line was
started in the right foreleg. During the evening the swelling was noted to extend up the left
leg and pain extended to the left axillary area. The next day he developed abdominal pain and
one episode of emesis occurred. On that morning, after skin testing, ten vials of antivenin
(Crotalidae) polyvalent were administered over several hours. The following day the dog was
discharged with oral pain medication. He regained full use of his paw and leg. The table
contains the notable laboratory results.
Hb g/dl
PCV %
Platelets/ul
PT sec
APTT sec
Fibrinogen mg/dl
Laboratory Data
Patient
Day 1
Day 2
2200 (time) 0400 (time) 2200 (time)
14.0
12.9
12.2
40.0
37.7
35.3
ND
30000
115000
11.5
>120
13.0
35.9
>120
30.4
100
<50
<50
Day 3
1000 (time)
11.5
28.8
196000
11.9
28.8
240
Reference Range
(12 - 18)
(37 - 55)
(200 - 400)
(12-control)
(18-control)
(200 - 400)
This patient's progressive modest anemia reflects fluid therapy. At initial presentation the
patient did have a low fibrinogen concentration. Six hours later fibrinogen was not detectable,
platelet count was markedly reduced and PT and APTT were prolonged. Within 24 hours of
presentation the patient exhibited clinical improvement which was corroborated by the
laboratory tests.
This is a case of DIC secondary to snake envenomation. It is interesting to follow these tests
over time, especially with success.

Case

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Case Studies

Dept of Veterinary Pathobiology, School of Veterinary Medicine, Purdue University,

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Case 4: Canine 5 Year Old Spayed Female Sheepdog

Case 5: Feline 4 Year Old Castrated Male Domestic Longhair

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Case 8: Canine 5 Year Old Female Cocker Spaniel

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Case 11: Feline 10 Month Old Female Siamese

Case 12: Canine 1 Year Old Intact Male Collie

Case 13: Canine 1 Year Old Intact Female Boxer

Case 14: Feline 10 Year Old Castrated Male Tabby DSH

Case 15: Canine 14 Year Old Intact Female Cocker Spaniel

Case 16: Feline 9 Year Old Spayed Female Persian

Case 17: Feline 4 Year Old Intact Female DSH

Case 18: Canine 10 Year Old Female Sheltie

Case 19: Feline 4 Year Old Male DSH

Case 20: Canine 9 Year Old Female Golden Retriever

Case 21: Canine 2 Year Old Standard Poodle

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Case 23: Canine 9 Year Old Castrated Male Mixed Breed

Case 24: Canine 9 Year Old Spayed Female Corgi

Case 25: Canine 11 Year Old Spayed Female Basset Hound

Case 26: Feline 7 Year Old Male Domestic Shorthair

Case 27: Canine 12 Year Old Mixed Breed Male

Case 28: Canine 7 Year Old Mixed Breed Spayed Female

Case 29: Canine 5 Year Old Mixed Breed Intact Male

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